Successful Management of Intraoperative Acute Bilateral Pulmonary Embolism in a High Grade Astrocytoma Patient

Abstract

Patient: Female, 39Final Diagnosis: Acute bilateral pulmonary embolismSymptoms: Headache • amnesia • seizure • urinary incontinenceMedication: —Clinical Procedure: —Specialty: AnesthesiologyObjective:Management of emergency careBackground:Intraoperative pulmonary embolism (PE) is a rare life-threatening complication in patients undergoing surgical intervention. Generally, cancer patients have a higher risk for developing this complication. Unfortunately, there is no standard procedure for its management.Case Report:We report the case of a 39-year-old woman with high-grade glioma in the right frontal lobe who was admitted to the surgical theater for craniotomy and excision of the tumor. During the general anesthesia procedure and just before inserting the central venous line, her end-tidal CO2 and O2 saturation dropped sharply. The anesthesiologist quickly responded with an aggressive resuscitation procedure that included aspiration through the central venous line, 100% O2, and IV administration of ephedrine 6 mg, colloid 500 mL, normal saline 500 mL, and heparin 5000 IU. The patient was extubated and remained in the supine position until she regained consciousness and her vital signs returned to normal. Subsequent radiological examination revealed a massive bilateral PE. A retrievable inferior vena cava (IVC) filter was inserted, and enoxaparin anticoagulant therapy was prescribed to stabilize the patient’s condition. After 3 weeks, she underwent an uneventful craniotomy procedure and was discharged a week later under the enoxaparin therapy.Conclusions:The successful management of intraoperative PE requires a quick, accurate diagnosis accompanied with an aggressive, fast response. Anesthesiologists are usually the ones who are held accountable for the diagnosis and early management of this complication. They must be aware of the possibility of such a complication and be ready to react properly and decisively in the operation theater.

Recurrent pulmonary thromboembolism during radical cystectomy: A case report

“…There is emerging evidence for the role of pulmonary vasodilators in PE [9]. Intraoperative massive PE, possibly from tumor thrombi, has also been reported in a patient planned for craniotomy for astrocytoma before the start of surgery [15]. The patient was managed with hemodynamic resuscitation, inferior vena cava filter placement, and anticoagulation.…”

Case of intraoperative acute pulmonary embolism diagnosed by transesophageal echocardiography under general anesthesia and successfully managed with extracorporeal membrane oxygenation

“…Hence, its early diagnosis and treatment are important for saving the patient’s life, 10 and the disease should be considered as one of the possible differential diagnoses in cases with unexplained changes in hemodynamics and oxygenation perioperatively, as in this case. In addition, while there are several reports of PTE in the perioperative period that were treated with anticoagulation, 1 , 10 , 11 there are only a few reports of its surgical treatment. Therefore, this case is significant to report.…”